Is 24-hour operating room staff absolutely necessary for level II trauma center designation?

Recent papers from established trauma centers reported average elapsed times from emergency department (ED) admission to the operating room (OR) of greater than 100 minutes for patients judged to be in immediate need of surgery. This study was undertaken to determine whether patients treated at an institution desiring level II trauma center designation in a geographic area with a low incidence of penetrating trauma suffered any adverse effects because of lack of a 24-hour in-house OR staff. Trauma registry data at The Stamford Hospital, a suburban community teaching hospital without OR nursing staff in-house at night, were reviewed and compared with data from three affiliated level I trauma centers and with established national standards using TRISS methodology. Of 659 major trauma patients, 86 (44 blunt, 42 penetrating) underwent surgery within 12 hours of admission. Patients' injuries were similar in severity to those seen at the affiliated trauma centers and to the Major Trauma Outcome Study population. Mortality rates were also similar. No statistically significant differences were seen in elapsed times from ED arrival to OR arrival even in the subgroup of patients with systolic blood pressure values of < or = 90 mm Hg. No unexpected adverse outcomes could be ascribed to the lack of 24-hour OR staffing in this setting. The estimated cost of providing additional OR staffing is $145,000 per year. Since times to the OR and outcomes were similar to those at level I centers, this expense may not be warranted.